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Med/Surg Test 4- RA & Osteoarthritis
Terms in this set (43)
A chronic and inflammatory disease that affects the joints in the body that is systemic
What is affected by Rheumatoid arthritis?
Any joint component, including cartilage, muscles; ligaments, synovial membranes, as well as the blood vessels may be affected
What other things can Rheumatoid arthritis affect?
may also affect soft tissues found in the body, including the eyes and lungs
Joint stiffness that occurs in the morning for longer than 30 minutes
Rheumatoid arthritis is considered a _____ _____, the prognosis has greatly improved with the development of medications which potentially slow joint damage and disease progression.
Who is affected by Rheumatoid arthritis?
-Most often noticed between the ages of 20 and 50
-Rheumatoid arthritis is more commonly found in women than in men- 3x more likely
Is there a known cure for Rheumatoid arthritis?
Rheumatoid arthritis most frequently attacks the?
Wrists, hands, elbows, shoulders, knees, and ankles
RA usually affects the joints
Symmetrically (on both sides)
S/S of RA can include:
-Swelling around the joint.
-Loss of motion in the joint
-Diminshed circulation and cap refill
Effects of RA include:
Disease can progress to the degree that it is crippling causing the patient to become bed bound; deformities distinctive to to late-stage rheumatoid arthritis such as ulnar deviation of the bones of the hands, or swan-neck deviation of the fingers occur because muscles and tendons on one side of the joint may overpower those on the other side, pulling the bones out of alignment
How to diagnose RA
Medical history; physical exam; xrays or other imaging procedures; blood and lab tests
Lab tests may include
-Antinuclear antibody test
-Sampling the synovial fluid
-Erythrocyte sedimentation rate
What blood test is usually done first in diagnosing RA?
Antinuclear antibody (ANA) test
Non-drug treatment of RA
-Heat/cold applications based on pt response
-Hot shower to relieve stiffness; heated paraffin
-Edema sometimes relieved with cold therapy
-PT- ROJM, electric stimulation or deep heat to improve joint mobility
Medication options to treat RA
-DMARDS - disease-modifying anti- rheumatic drugs which arespecific for RA
What should monitored corticosteroids are used long term?
Their sugar should be monitored
Other treatment of RA
Topical remedies such as Ben Gay or Voltaren gel and joint surgery
Also known as systemic onset juvenile RA characterized by chronic fever and anemia
Juvenile RAcan also have secondary effects on the
heart, lungs, eyes, and nervous system
Treatment for juvenile RA:
-Is essentially the same as for adults, with heavy emphasis on physical therapy and exercise to keep growing bodies active.
-Permanent damage from juvenile rheumatoid arthritis is now rare, and most affected children recover from the disease fully without experiencing any lasting disabilities
A degenerative joint disease that affects cartilage, subchondral bone and synovium that is not systemic
Osteoarthritis is often thought to result from?
"Wear and tear" on a joint
Risk factors for osteoarthritis
-Previous joint damage
Which is not a modifiable risk factor for developing OA?
C- Repetitive recreational use
D- Joint pain
Obesity and repetitive use are modifiable &Pain is a symptom not a risk factor
S/S of osteoarthritis include:
-Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest
-Pain that is worse when you start activities after a period of no activity
-Over time, pain is present even when you are at rest
-Joint movement may cause a cracking /grating "Crepitis" sound
-Increase in pain during humid or moist weather
-Muscle weakness around arthritic joints
What are the goals of treatment of OA?
Increase the strength of the joints; Maintain or improve joint movement; Reduce the disabling effects of the disease; Relieve pain; The treatment depends on which joints are involved
Lifestyle recommendations for OA
Exercise helps maintain joint and overall movement; Water exercises; Applying heat and cold; Eating a healthy, balanced diet; Getting rest; Losing weight if you are overweight; Protecting the joints
Is there a blood test that is helpful in diagnosing osteoarthritis?
What will a someone with OA show in a physical exam ?
Joint swelling (bones around the joints may feel larger than normal);Limited range of motion; Tenderness when the joint is pressed; Normal movement is often painful
What would a xray show with someone with OA?
A loss of the joint space in the affected joints. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.
Medication treatment of OA
-Over-the-counter pain relievers can help with symptoms- Tylenol
-Types of NSAIDs include aspirin, ibuprofen, and naproxen.
-Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs.
-Corticosteroids injected right into the joint- relief lasts only a short time
-Supplements: glucosamine and chondroitin sulfate.
______ ______ ______ can be injected into the knee to help relieve pain in clients with OA. It may relieve pain for ___ to ___ months
Artificial joint fluid
3 to 6
A patient my ask for this if other treatments do not work for OA?
Capsaicin (Zostrix) skin cream
A cream that may relieve pain from OA
A way to prevent osteoarthritis?
Weight loss; weight loss can reduce the risk of knee osteoarthritis in overweight women
Treatment of OA generally improves function giving more ______ __ _____
range of motion
A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following clinical manifestations should the nurse expect to find? (select all that apply)
a) Heberden's nodes
b) Swelling of all joints
c) Small body frame
d) Enlarged joint size
e) Limping when walking
a) Heberden's nodes are enlarged nodules on the distal interphalangeal joints of the hands and feet of a client who has OA.
d) A client may manifest enlarged joints due to bone hypertrophy.
e) A client may manifest a limp when walking due to pain from inflammation in the localized joint.
A nurse is providing information to a client who has OA of the hip and knee. Which of the following information should the nurse include in the information? (select all that apply)
a) Apply heat to joints to alleviate pain.
b) Ice inflamed joints following activity.
c) Install an elevated toilet seat.
d) Take tub baths.
e) Complete high-energy activities in the morning.
a) Applying heat to joints can provide temporary relief of pain.
b) Applying ice to inflamed joints following activity can decrease edema.
c) Installing an elevated toilet seat can help decrease strain and pain of the affected joints.
e) Encouraging high-energy activity in the morning is recommended as part of a daily routine to promote independence.
A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from OA. Which of the following information should the nurse include in the discussion?
a) Continuous pain relief is provided.
b) Inspect for skin irritation and cuts prior to application.
c) Cover the area with tight bandages after application.
d) Apply the medication every 2 hours during the day.
b) Inspect the skin for irritation and cuts before applying, because hot peppers in the cream can cause a painful burning sensation in areas of skin breakdown.
A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis. The client reports increased joint tenderness and swelling. Which of the following are indicative of this diagnosis? (select all that apply)
a) Exacerbating factors
b) Range of motion
c) Date of original diagnosis
d) Blood pressure
e) Pain status
a) Exacerbating factors, such as a recent illness, are indicative of RA.
b) Range of motion is indicative of RA.
e) Pain is indicative of RA.
A nurse is caring for a client who has RA. Which of the following lab tests are used to diagnose this disease? (select all that apply)
b) Erythrocyte sedimentation rate (ESR)
d) Antinuclear antibody (ANA) titer
e) WBC count
b) ESR. This test will show an elevated result in clients who have RA.
d) ANA. This test will show a positive result in clients who have RA.
e) WBC. This test will show a decreased result in clients who have RA.
A nurse is providing information to a client newly diagnosed with RA. Which of the following statements by the nurse is appropriate?
a) "You may experience morning stiffness when you get out of bed"
b) "You may experience abdominal pain"
c) "You may experience weight gain"
c) "You may experience low blood sugar"
a) The client can experience stiffness in her joints upon rising.
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